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Minimal intervention management of the older patient

Key Points

  • Discusses protection of root surfaces in older patients.

  • Suggests that a maximum interception approach means that specific efforts are needed to profile salivary, plaque and lifestyle risk factors.

  • Discusses the best ways to make the dentition able to be easily maintained.

  • Highlights how important it is to engage with other members of the health care team in oral health planning.

Abstract

With an aging population, dentists need to be aware of the risks which come to their elderly patients from retained teeth and exposed root surfaces. Oral health problems in the later years of life are multifactorial, with lifestyle, plaque and salivary factors remaining paramount. Root surface caries is likely to present a challenge in patients with a strong history of past coronal caries (and who have the attendant lifestyle risk factors) as well as in elderly patients who suddenly develop salivary hypofunction. Following a maximum interception approach means that specific efforts are needed to profile salivary, plaque and lifestyle risk factors and ensure that the dentition can be cleaned by the patient and maintained in a way which gives comfort and function as well as aesthetics. Discussions around long-term objectives for oral health are important when there is a sudden decline in general health in the later years of life. It may be appropriate to use tooth surface protection for strategic anterior teeth and apply the shortened dental arch concept where patients cannot readily maintain their own oral health because of frailty or medical conditions. Glass ionomer materials can be used both for root surface protection and for conservative restoration where a minimally invasive preparation has been undertaken. In other cases, arrest of lesions using silver fluoride or CPP-ACP topical treatments can delay or obviate the need for restorative interventions, and forms part of the management of patients in high care units in nursing homes. Involving all members of the healthcare team in supporting oral health is an important strategy to ensure that oral health issues are not overlooked. The challenge is to promote evidence-based self-care. A key message is to promote oral health as part of overall health.

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Figure 1: Issues with root surfaces and their management in elderly patients.
Figure 2: Multi-colour plaque disclosing.
Figure 3: Profiling of salivary parameters.

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Walsh, L. Minimal intervention management of the older patient. Br Dent J 223, 151–161 (2017). https://doi.org/10.1038/sj.bdj.2017.660

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